Sunday, July 17, 2005

Look Upon This, Rumsfeld, and Weep

I had posted too many politically-oriented things lately, so I went to one of my favorite sources of medical news: Medscape.  Medscape almost never publishes anything with political implications, except those pertaining to health policy.  The following article appears to have been so compelling that they made an exception. (Free registration required)
Medical Investigations of Homicides of Prisoners of War in Iraq and Afghanistan
Steven H. Miles, MD
Medscape General Medicine.  2005;7(3) 2005 Medscape
Posted 07/05/2005


The publication of the photographs of the abuse of prisoners at Abu Ghraib has resulted in a widening circle of disclosures and official investigations of similar abuses in Iraq, Afghanistan, and at Guantanamo Bay. There are reports that some medical personnel neglected detainees' medical needs and collaborated with coercive interrogations.[1,2] Some physicians, medics, nurses, and physician assistants failed to report abuses or injuries caused by the abuses that they witnessed. This article reviews another human rights issue -- the medical evaluation of cases of which prisoners potentially died of because of mistreatment or under suspicious circumstances. [...]
I've posted before on the fact that medical personnel were involved in interrogations, contrary to established medical ethics, and contrary to US military policy.  The Medscape article amplifies and confirms prior allegations of a different sort: medical personnel failed to provide adequate investigation and documentation of the deaths of detainees.  

The article quotes the applicable Geneva Conventions, which apply broadly to "internees."  The significance of this is that it does not matter why the person was being detained.  Thus, the internee's status, whether as prisoner of war, unlawful combatant, or innocent bystander, does not matter.  

The article details many specific examples of incomplete or misleading autopsy reports, mishandled forensic evidence, and obstructed death investigations.  Furthermore, it documents cases in which military personnel wither were not charged with crimes, or were given minor punishments:
Even when investigators found a criminal homicide, the US Department of Defense was reluctant to prosecute those involved or who were aware of the abuse. A soldier who shot a prisoner to death was not prosecuted because he was not informed about the rules for using force against prisoners.[38] At Camp Bucca in September 2003, an International Committee of the Red Cross monitor saw a guard shoot a prisoner in the chest. The monitor said, "The shooting showed a clear disregard for human life and security of the persons deprived of their liberty.[9]" The US Army concluded that the shooting was justifiable. Escaping, nonthreatening detainees were shot on other occasions.[39] The base commander at Tikrit prison used an administrative procedure to preempt the prosecution of the soldier who killed Obeed Hethere Radad (see Table ). Most of the soldiers prosecuted for criminal homicides of prisoners received nonjudicial punishments, such as a reduction in rank, and the record of charges, punishments, and even the name of the victim are sealed.[3]
Dr. Miles concludes with remarkable restraint:
The failures of the Armed Forces Institute of Pathology have had diverse adverse consequences. A death monitoring system, which might have led to earlier awareness and prevention of homicides and abuse caused by torture, was never operational. Mishandled evidence and incomplete evaluations allowed alleged perpetrators of lethal torture to go unprosecuted. The failure to integrate the completion of death certificates into a Geneva-mandated system for notifying relatives of deaths compounded the grief, anger, and uncertainty of families. Bodies were administratively buried rather than being interred by relatives with proper ceremonies in the family's chosen place of interment. Our national reputation and interests were harmed by these failures.
Yes, our national reputation and interests were harmed.  The reputation of the medical profession has been harmed.  The reputation of the US and British military forces were harmed.  Somehow, though, the politicians have been given a pass.
Update: as pointed out by Dr. DeFACCto from Cardioblog, there's a pertinent op-ed piece by By Burton J. Lee III, M.D., in the Washington Post, here.